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Is diaphragmatic hernia causing problems?

Species: Dog
Breed: Cocker Spaniel
Age: 11-15 years
My 15 year old doggie, Pepper has been diagnosed with a diaphragmatic hernia & the Specialist we seen said since no one is sure when it happened or if it is congenital, they would not recommend surgery. I have had her since a small pup & have no knowledge of her being kicked or falling from anything, & I know she has never been hit by a car, so I am guessing it is congenital. About three months ago she had a rather large growth removed from her rear end just to the left of her anus & a "mole" removed from her lower left lip right at the corner of her mouth (she has them all over her body some of them bust open & seep). When the Vet done her surgery he kindly removed some plaque from her teeth, without me even asking (I had asked her old Vet to do it probably 5 years prior but they did not want to "put her under" because of her age)I was very appreciative that he done this! I brought her home the next day with a prescription of Cephalexin & she done well for about a week, other than the fact that she wouldn't take food from the left, she had a squeak when she chewed (she still has that sometimes)& some of her food would just fall right out of her mouth (I figured it was all from the stitches). She had surgery on a Friday & the following Saturday she started vomiting up bile, she has done this from time to time in the past but never lasted more than a day. Well this time was different, she threw up 3 times that morning & for a week after she threw up bile anywhere from 1 to 3 times a day, even if she had just eaten the only thing that came up was the yellow bile, the food stayed down. After a week of that I took her back to the Vet(she also needed her stitches out). They checked her & she was running a slight temp, which the Vet said could have just been from her being anxious from the ride there. She had lost a pound & when I told her Vet what was going on they recommended doing a CBC test & suggested that Pepper may have acid reflux. We done the CBC test & she gave me some pepcid & anti nausea meds to take home & try. She was still throwing up & swallowing really hard (dropping her chin to her chest & pulling her head back while keeping her chin down to her chest) for about 5 more days. I had gotten the CBC results & for a doggie her age the Vet said everything looked pretty good. Her iron was down a little, her electrolytes were slightly low, (but thought that was from her being anxious from the car ride there before having her blood drawn) her liver enzymes were off a little & her Vet thought she might be in the beginning stages of a bile duct blockage so she started her on a prescription of Ciprofloxacin & Prednisone they also gave her more meds for the nausea. I gave her the nausea meds the next morning & about 20 minutes after taking them threw up bile, but that was the last time. Around that time she started having very labored breathing (panting), excessive drooling (long slimy strings from both sides of her mouth) & still swallowing hard. I was having a hard time finding something she would eat, I was giving her peanut butter sandwiches to make sure she was getting all her meds but was afraid that was not enough. She has been eating Purina Beneful Healthy weight formula for at least 10 years,she had never gotten table scraps or other human food, besides vegetables (she loves corn, green beans, peas, lettuce, even watermelon & cantaloup) I couldn't get her to eat any of those things. I talked to her Vet & they said they were not sure what was wrong with her so they recommended a Specialist, so I called & made an appointment. They couldn't get me in for two weeks, within that time I was doing research online & I had found something that matched some of her symptoms (by this time she had started heaving up a really thick white foamy mucus also & heaving hard enough she would fall over from being short of breath, also pacing & panting really hard) what I found was congestive heart failure & also learned it could be diagnosed with an x-ray. I then contacted a local Vet that advertised having an x-ray machine, was open on Saturdays & took her in. They done the x-ray & said she did have a slightly enlarged heart & gave me Enalapril & Furotabs (very low dose of each until I seen the Specialist) & recommended a low sodium diet. I went to the pet store & found that most dog foods don't list their sodium content, but did find a vegetarian dog food that had it listed & said low sodium, the Vet also said I could try baby food so I tried it also, she would eat the baby food but not the other. Peppers first trip to the Specialist ended with me finding out she had swollen salivary glands (which she thought could be Phenobarbital responsive sialadenosis) plus arthritis in her neck & back. She was concerned with the hard swallowing because she was not sure if it was that or a possible seizure, so she told me to count how many times I seen Pepper do it in a day & let her know. She also told me to take Pepper off of the heart meds. I counted how many times she swallowed hard the next day & in two hours that morning before I went to work she had done it 20 times & within an hour that evening she had done it another 10 times, so I let the Specialist know & she prescribed Phenobarbital. I started her on it & finally found a canned dog food that she would eat & she is has continued eating. She had slowed way down on the hard swallowing so I tried to get her to eat some of her soft treats & her Beneful & she would chew the treats into pieces but not swallow them & her salivary glands were still swollen after more than a month of taken the Phenobarbital, so I made a second appointment with the Specialist. Pepper was still heaving really hard until she would throw up that white foamy mucus & falling over from loss of oxygen, she also sounded really rattly (like she had a lot of mucus in her sinuses) when she was pacing & panting, so I asked them to do an x-ray of her lungs to make sure she didn't have pneumonia & that is when they found the hernia. She asked me if Pepper had been kicked by a horse or hit by a car & I told her not since I have had her & she was just weened when I got her, so they are thinking it is congenital. We were sent home with Clindamycian, Carprofen (50mg once a day)& told to stay on the Phenobarbital since it seemed to have helped with the hard swallowing. She has ate a little of her Beneful & I have got her to eat some Dentastixs, which makes me feel a little better. What I need to know is, is there anything I can do to make her more comfortable? Do you recommend another type of pain medicine or perhaps just more of the type she is taking? I don't have children & she is my baby, I hate seeing her like this, I don't know if she is really in pain, I haven't heard her make a noise, bark, whine, yelp, or whimper in over a month. I can tell when she paces & pants she is a little anxious & I try to calm her down but I am not sure what to do because even if I try to hold her she will only stay for a few minutes then she is right back to pacing. Please help me, help my baby girl. Thank you for your time.

Online vet, Dr. Marie

Dr. Marie replied:

Thank you for the detailed explanation of what is happening to Pepper. The poor girl has been through a lot lately, and so have you.

The problem with cases like this is that it is really hard to know what to do because we don't know the actual cause of the symptoms that we are seeing. The problem could be because of the hernia. I agree with you that it is likely that the hernia is congenital and has always been there. But, it is possible that something shifted in the hernia during the time under anesthetic. (This is not to say that it is anyone's fault - it would have just been something that happened.) I have seen cases where a hernia is present but all that is present is a hole in the diaphragm. But, at some point in life the organs decide to enter the hole and sit in the chest. This can suddenly make the hernia problematic. If this is what is happening then the symptoms may not get better without surgery. But doing surgery would be risky because 1) we don't know for sure if the hernia is the cause of the problems and 2) the surgery is risky even on a young dog, and moreso on an older dog. Also this surgery would be very expensive.

It's also possible that these issues are because of a heart related problem. The neurological symptoms you are describing such as difficulty with food coming out the side of her mouth could be indicative of a stroke. We don't see many strokes in dogs but they can happen, especially if there is underlying heart disease. If this is the case then slow recovery is possible but there is not much more that you can be doing.

You could consider having an ultrasound done of Pepper's heart to help determine if the heart is the main problem. But the problem here is that it likely won't change what treatment options you have. What it may do, however, is give you an idea of how bad things are. If there are signs of obvious serious damage to the heart then it may be easier to start thinking about whether euthanasia should be considered.

It sounds like you are getting really good veterinary care. I know how frustrating it can be when your vets can't give you answers and seem to be trying one thing after the other without any apparent success. It does sound like your vets are doing all of the right things though. I would really trust their judgement and they will help you make decisions through this process.

This next part may be hard to read, but I wanted to let you know that it is ok to start considering euthanasia. At 15, Pepper is an elderly girl. If she is not enjoying life and treatments are not helping her then there is a high chance that her problems are ones that we will not be able to fix. I know it is hard to think about euthanasia when we dont' know exactly what is wrong. But I wanted to let you know that this is a valid option to consider.

I'm sorry I can't give you any exact answers as far as what else can be done. Hopefully this information has been helpful, but please respond if you have more questions.

Dr. Marie

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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

Thank you for getting back to me so quickly. I wanted to let you know that God made the decision for me last night, she past around 2am. Even though my heart is broken I know she is no longer suffering & that is a relief to me. I will miss my baby girl something fierce & will always cherish the memories of her, I could not have asked for a better doggie. Thanks again.

Online vet, Dr. Marie

Dr. Marie replied:

Oh I am so sorry to hear that. It sounds like you did so much for her.

Dr. Marie

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.